Treatment of COVID-19 pediatric patients entails supportive and symptomatic management. Unfortunately, no RCTs have included pediatric patients, to date. The available evidence is obtained from adult studies. Remdesivir is the only USFDA-approved anti-COVID-19 medication indicated in the majority of symptomatic patients with moderate to severe disease. According to the USFDA, remdesivir is recommended in hospitalized children aged 12 years and above, and weighing at least 40 kg. But, the use of remdesivir is not advised in patients with impaired renal functions and particularly in those with a glomerular filtration rate below 30 ml/min.
The addition of tocilizumab to the medical regimen is favored particularly in pediatric patients with MIS-C. These patients should likely receive antiplatelet medications such as aspirin and anticoagulant medications such as enoxaparin that can prevent the occurrence of thromboembolic events. Additionally, the USFDA has authorized the emergency use of bamlanivimab and casirivimab/imdevimab to non-hospitalized COVID-19 patients aged 12 years and above and weighing at least 40 kg who are at high risk for the complicated disease. Pediatric patients requiring oxygen or respiratory support should not receive these medications.
Dexamethasone is solely recommended in patients with respiratory distress maintained on oxygen or ventilatory support. Other medications, such as hydroxychloroquine, azithromycin, and ivermectin among others can be occasionally considered in non-remdesivir candidates. Supportive care, consisting of fluids supplementation and antipyretics, should be offered to all patients regardless of the disease severity.
Finally, vaccination remains the ultimate prevention method that may control the spread of COVID-19 and reduce its fatality. Considering the safety of the anti-COVID-19 drugs among pediatric patients, high-quality RCTs involving pediatric patients are urgently needed.
Source: Pharmacological Reports